tbuckley/cabot-search huggingface dataset:
FDA Regulations of AI-Driven Clinical Decision Support Devices Fall Short
Authors: Anand R. Habib, Cary P. Gross
Journal: JAMA Internal Medicine (2023)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Internal Medicine HomeNew OnlineCurrent IssueFor Authors Podcast Journals JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2024 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Internal Medicine journal
Machines Like Me: 4 Corollaries for Responsible Use of AI in the Bioethics Classroom
Authors: Craig M. Klugman, Cheryl J. Erwin
Journal: The American Journal of Bioethics (2023)

Click to increase image sizeClick to decrease image sizeThis article refers to:What Should ChatGPT Mean for Bioethics?Ethics Education for Healthcare Professionals in the Era of ChatGPT and Other Large Language Models: Do We Still Need It? DISCLOSURE STATEMENTNo potential conflict of interest was reported by the author(s).Notes1 ChatGPT3.5 initially refused to create a case study from the same prompt, stating that to do so would be inappropriate. However, when I requested it do so for a “class case study” the system described a 76-year-old, poor, Black woman with pancreatic cancer.Additional informationFundingThe author(s) reported there is no funding associated with the work featured in this article.
Inhibition of PORCN Blocks Wnt Signaling to Attenuate Progression of Oral Carcinogenesis
Authors: Daniel Peña-Oyarzún, Tania Flores, Vicente A. Torres, Andrew F.G. Quest, Lorena Lobos-González, Catalina Kretschmar, Pamela Contreras, Andrea Maturana-Ramírez, Alfredo Criollo, Montserrat Reyes
Journal: Clinical Cancer Research (2023)

Abstract Purpose: Oral squamous cell carcinoma (OSCC) is commonly preceded by potentially malignant lesions, referred to as oral dysplasia. We recently reported that oral dysplasia is associated with aberrant activation of the Wnt/β-catenin pathway, due to overexpression of Wnt ligands in a Porcupine (PORCN)-dependent manner. Pharmacologic inhibition of PORCN precludes Wnt secretion and has been proposed as a potential therapeutic approach to treat established cancers. Nevertheless, there are no studies that explore the effects of PORCN inhibition at the different stages of oral carcinogenesis. Experimental Design: We performed a model of tobacco-induced oral cancer in vitro, where dysplastic oral keratinocytes (DOK) were transformed into oral carcinoma cells (DOK-TC), and assessed the effects of inhibiting PORCN with the C59 inhibitor. Similarly, an in vivo model of oral carcinogenesis and ex vivo samples derived from patients diagnosed with oral dysplasia and OSCC were treated with C59. Results: Both in vitro and ex vivo oral carcinogenesis approaches revealed decreased levels of nuclear β-catenin and Wnt3a, as observed by immunofluorescence and IHC analyses. Consistently, reduced protein and mRNA levels of survivin were observed after treatment with C59. Functionally, treatment with C59 in vitro resulted in diminished cell migration, viability, and invasion. Finally, by using an in vivo model of oral carcinogenesis, we found that treatment with C59 prevented the development of OSCC by reducing the size and number of oral tumor lesions. Conclusions: The inhibition of Wnt ligand secretion with C59 represents a feasible treatment to prevent the progression of early oral lesions toward OSCC.
Letter to the Editor: Outbreak of indeterminate acute hepatitis in children, not a new disease but an epidemiological phenomenon
Authors: Barath Jagadisan, Anil Dhawan
Journal: Hepatology (2023)

To the editor, We read with interest the review by Elsheikh et al.1 They have appropriately focused on indeterminate acute hepatitis and the resulting liver failure. They describe the 2021–2022 outbreak of indeterminate acute hepatitis, as understood in July 2022. We write to explain how recent data have changed the understanding of the disease. The authors mention that hepatitis of unknown origin shows similarities to pediatric acute liver failure (PALF), thus making a distinction. PALF is not a separate disease but a serious complication of various causes of acute hepatitis, including that of indeterminate etiology. To avoid confusion, we suggest using the standard terminology of indeterminate acute hepatitis rather than hepatitis of unknown origin or non-A-E hepatitis. The authors compare the cases during the outbreak to adenoviral hepatitis in immunocompromised children. The recent outbreak was in immunocompetent children. Reports on experience preceding the outbreak describe adenovirus-associated PALF in immunocompetent children as rare.2 Our data showed that adenovirus-associated acute hepatitis leading to PALF in immunocompetent children is not a new disease or a rare phenomenon.3 The association of indeterminate PALF (ID-PALF) with adenovirus infection has been a regular phenomenon (46% of all ID-PALF in 2017–2019) except during the social distancing in 2020–2021 followed by a spike of such association in 2022. It paralleled background community rates of adenovirus infection. ID-PALF persisted in 2020–2021 despite the absence of the association. This questions the causality of the adenovirus in ID-PALF. Direct cytotoxicity is unlikely, as hepatocytes lacked immunohistochemically demonstrable adenovirus in adenovirus-associated ID-PALF. Adenovirus-associated ID-PALF during the 2022 outbreak exhibited a severe phenotype compared with cases in 2017–2019, although the native liver survival was similar. Recent data implicated immunological injury against adeno-associated virus-2 for the outbreak.4 In such a scenario, the role of adenovirus is that of a helper virus. The authors refer to the use of intravenous immunoglobulins in immunocompromised children with adenoviral hepatitis. It remains an adjuvant to cidofovir in managing immunocompromised children. Our use of cidofovir in immunocompetent children with adenovirus-associated ID-PALF was driven by the high adenoviremia in PALF which induces a state of immune paralysis, with some of the children headed for liver transplantation and posttransplantation immunosuppression.5
Effect of transarterial chemoembolization as postoperative adjuvant therapy for intermediate-stage hepatocellular carcinoma with microvascular invasion: a multicenter cohort study
Authors: Cailing Xiang, Xianbo Shen, Xinxin Zeng, Yuzhong Zhang, Zhongzhi Ma, Guocan Zhang, Xin Song, Tao Huang, Juan Yang
Journal: International Journal of Surgery (2023)

Background: Intermediate-stage hepatocellular carcinoma (HCC) with microvascular invasion (MVI) is associated with high recurrence rates and poor survival outcomes after surgery. This study aimed to evaluate the efficacy of postoperative transarterial chemoembolization (TACE) on prognosis of intermediate-stage HCC patients with MVI after curative liver resection (LR). Materials and Methods: Patients who had intermediate-stage HCC with MVI and underwent curative liver resection between January 2013 to December 2019 at three institutions in China were identified for further analysis. Overall survival (OS) and recurrence-free survival (RFS) were compared between patients treated with and without postoperative TACE by propensity score–matching (PSM). Results: A total of 246 intermediate-stage HCC patients with MVI were enrolled, 137 entered into the LR group and 109 entered into the LR+TACE group. The 1-, 3-, and 5-year RFS rates were 42.0%, 27.2% and 17.8% in LR+TACE group, and 31.8%, 18.2% and 8.7% in LR group. The 1-, 3-, and 5-year OS rates were 81.7%, 47.2% and 26.1% in LR+TACE group, and 67.3%, 35.6% and 18.5% in LR group. Compared with LR alone, LR+TACE was associated with significantly better RFS (hazard ratio [HR], 1.443; 95% confidence interval [CI], 1.089-1.914; P =0.009) and OS (HR, 1.438; 95% CI, 1.049-1.972; P =0.023). No difference was observed with RFS and OS in single TACE and multiple TACE in the matched cohort. Conclusion: Postoperative adjuvant TACE could be beneficial for intermediate-stage HCC patients with MVI.
The impact of religion on changes in end-of-life practices in European intensive care units: a comparative analysis over 16 years
Authors: Joerg C. Schefold, Livio Ruzzante, Charles L. Sprung, Anastasiia Gruber, Eldar Soreide, Joseph Cosgrove, Sudakshina Mullick, Georgios Papathanakos, Vasilios Koulouras, Paulo Azevedo Maia, Bara Ricou, Martin Posch, Philipp Metnitz, Hans-Henrik Bülow, Alexander Avidan, C. Sprung, R. Bernstein, A. Avidan, Charles L. Sprung, Matthew Anstey, Alexander Avidan, Elie Azoulay, Julie Benbenishty, Du Bin, Deborah Cook, Randy Curtis, Charles Feldman, Christiane Hartog, Gavin Joynt, Motoshi Kainuma, Mitchell Levy, R. K. Mani, Andrej Michalsen, Bara Ricou, Marcio Soares, Robert Truog, D. Ledoux, C. Ingels, D. Nalos, J. Gjedsted, C. Hartog, S. Zakynthinos, C. Mathas, G. Nakos, B. Koulouras, G. Papathanakos, O. Miskolci, C. L. Sprung, A. Avidan, V. de la Guardia, A. Farran, V. Van Heerden, M. Klein, P. Levin, A. Palo, A. Girbes, P. Maia, L. Bento, J. M. G. Garcia, A. Vidal Tegedor, B. Ricou, S. Marsch, J. C. Schefold, F. Esen, D. Brealey
Journal: Intensive Care Medicine (2023)

Religious beliefs affect end-of-life practices in intensive care units (ICUs). Changes over time in end-of-life practices were not investigated regarding religions. Twenty-two European ICUs (3 regions: Northern, Central, and Southern Europe) participated in both Ethicus-1 (years 1999–2000) and Ethicus-2 studies (years 2015–2016). Data of ICU patients who died or had limitations of life-sustaining therapy were analysed regarding changes in end-of-life practices and patient/physician religious affiliations. Frequencies, timing of decision-making, and religious affiliations of physicians/patients were compared using the same definitions. In total, 4592 adult ICU patients (n = 2807 Ethicus-1, n = 1785 Ethicus-2) were analysed. In both studies, patient and physician religious affiliations were mostly Catholic, Greek Orthodox, Jewish, Protestant, or unknown. Treating physicians (but not patients) commonly reported no religious affiliation (18%). Distribution of end-of-life practices with respect to religion and geographical regions were comparable between the two studies. Withholding [n = 1143 (40.7%) Ethicus-1 and n = 892 (50%) Ethicus-2] and withdrawing [n = 695 (24.8%) Ethicus-1 and n = 692 (38.8%) Ethicus-2] were most commonly decided. No significant changes in end-of-life practices were observed for any religion over 16 years. The number of end-of-life discussions with patients/ families/ physicians increased, while mortality and time until first decision decreased. Changes in end-of-life practices observed over 16 years appear unrelated to religious affiliations of ICU patients or their treating physicians, but the effects of religiosity and/or culture could not be assessed. Shorter time until decision in the ICU and increased numbers of patient and family discussions may indicate increased awareness of the importance of end-of-life decision-making in the ICU.
<i>JAMA Neurology</i> Editorial Fellow
Authors: S. Andrew Josephson
Journal: JAMA Neurology (2023)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Neurology HomeNew OnlineCurrent IssueFor Authors Podcast Journals JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Neurology journal
Performance of the ESC/ERS 4-strata risk stratification model for pulmonary arterial hypertension with missing variables
Authors: Christine Pausch, David Pittrow, Marius M. Hoeper, Doerte Huscher
Journal: European Respiratory Journal (2023)

The 2022 European Society of Cardiology (ESC)/ European Respiratory Society (ERS) pulmonary hypertension (PH) guidelines recommend risk stratification to guide treatment decisions in patients with pulmonary arterial hypertension (PAH) [1, 2]. Risk, referring to the likelihood of death within 12 months, is estimated based on WHO functional class (FC), 6-minute walk distance (6MWD), and serum levels of brain natriuretic peptide (BNP) or N-terminal pro-BNP (NT-proBNP), using prespecified thresholds. A 3-strata model (categorizing risk as low, intermediate, or high) is recommended at time of diagnosis, whereas a 4-strata model (categorizing risk as low, intermediate-low, intermediate-high, or high) is recommended during the course of the disease. The 4-strata model was developed from the Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension (COMPERA) and cross-validated by the French PH registry [3, 4]. Both studies included patients when all three variables, i.e. , WHO-FC, 6MWD, and BNP/NT-proBNP were available at baseline. No formal assessment of the predictive value of the 4-strata model has been performed when one of these components were missing. Footnotes This manuscript has recently been accepted for publication in the European Respiratory Journal . It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article. Conflict of interest: Christine Pausch has no disclosures. Conflict of interest: David Pittrow has received fees for consultations from Actelion, Amgen, Aspen, Bayer, Biogen, Boehringer Ingelheim, Daiichi Sankyo, MSD, Novartis, Sanofi-Genzyme, Takeda, Viatris and Zambon. Conflict of interest: Marius M. Hoeper has received fees for lectures and/or consultations from Acceleron, Actelion, AOP Health, Bayer, Ferrer, GSK, Janssen, MSD, and Pfizer. Conflict of interest: Doerte Huscher has no disclosures.
ChatGPT and the Law of the Horse
Authors: Alexander T. M. Cheung, Mustafa Nasir-Moin, Eric K. Oermann
Journal: The American Journal of Bioethics (2023)

Click to increase image sizeClick to decrease image sizeThis article refers to:What Should ChatGPT Mean for Bioethics? DISCLOSURE STATEMENTNo potential conflict of interest was reported by the author(s).Additional informationFundingThe author(s) reported there is no funding associated with the work featured in this article.
Large Language Model−Based Chatbot vs Surgeon-Generated Informed Consent Documentation for Common Procedures
Authors: Hannah Decker, Karen Trang, Joel Ramirez, Alexis Colley, Logan Pierce, Melissa Coleman, Tasce Bongiovanni, Genevieve B. Melton, Elizabeth Wick
Journal: JAMA Network Open (2023)

Importance Informed consent is a critical component of patient care before invasive procedures, yet it is frequently inadequate. Electronic consent forms have the potential to facilitate patient comprehension if they provide information that is readable, accurate, and complete; it is not known if large language model (LLM)-based chatbots may improve informed consent documentation by generating accurate and complete information that is easily understood by patients. Objective To compare the readability, accuracy, and completeness of LLM-based chatbot- vs surgeon-generated information on the risks, benefits, and alternatives (RBAs) of common surgical procedures. Design, Setting, and Participants This cross-sectional study compared randomly selected surgeon-generated RBAs used in signed electronic consent forms at an academic referral center in San Francisco with LLM-based chatbot-generated (ChatGPT-3.5, OpenAI) RBAs for 6 surgical procedures (colectomy, coronary artery bypass graft, laparoscopic cholecystectomy, inguinal hernia repair, knee arthroplasty, and spinal fusion). Main Outcomes and Measures Readability was measured using previously validated scales (Flesh-Kincaid grade level, Gunning Fog index, the Simple Measure of Gobbledygook, and the Coleman-Liau index). Scores range from 0 to greater than 20 to indicate the years of education required to understand a text. Accuracy and completeness were assessed using a rubric developed with recommendations from LeapFrog, the Joint Commission, and the American College of Surgeons. Both composite and RBA subgroup scores were compared. Results The total sample consisted of 36 RBAs, with 1 RBA generated by the LLM-based chatbot and 5 RBAs generated by a surgeon for each of the 6 surgical procedures. The mean (SD) readability score for the LLM-based chatbot RBAs was 12.9 (2.0) vs 15.7 (4.0) for surgeon-generated RBAs ( P = .10). The mean (SD) composite completeness and accuracy score was lower for surgeons’ RBAs at 1.6 (0.5) than for LLM-based chatbot RBAs at 2.2 (0.4) ( P &amp;amp;lt; .001). The LLM-based chatbot scores were higher than the surgeon-generated scores for descriptions of the benefits of surgery (2.3 [0.7] vs 1.4 [0.7]; P &amp;amp;lt; .001) and alternatives to surgery (2.7 [0.5] vs 1.4 [0.7]; P &amp;amp;lt; .001). There was no significant difference in chatbot vs surgeon RBA scores for risks of surgery (1.7 [0.5] vs 1.7 [0.4]; P = .38). Conclusions and Relevance The findings of this cross-sectional study suggest that despite not being perfect, LLM-based chatbots have the potential to enhance informed consent documentation. If an LLM were embedded in electronic health records in a manner compliant with the Health Insurance Portability and Accountability Act, it could be used to provide personalized risk information while easing documentation burden for physicians.
How Can Large Language Models Support the Acquisition of Ethical Competencies in Healthcare?
Authors: Jilles Smids, Maartje Schermer
Journal: The American Journal of Bioethics (2023)

Click to increase image sizeClick to decrease image sizeThis article refers to:Ethics Education for Healthcare Professionals in the Era of ChatGPT and Other Large Language Models: Do We Still Need It? DISCLOSURE STATEMENTNo potential conflict of interest was reported by the author(s).Additional informationFundingThe author(s) reported there is no funding associated with the work featured in this article.
Antibiotic Use Among Infants Admitted to Neonatal Intensive Care Units
Authors: Dustin D. Flannery, Alvaro Zevallos Barboza, Sagori Mukhopadhyay, Kelly C. Wade, Jeffrey S. Gerber, Di Shu, Karen M. Puopolo
Journal: JAMA Pediatrics (2023)

This cross-sectional study examines antibiotic exposure, days of therapy, types of antibiotics, and changes in use patterns among newborns in neonatal intensive care units (NICUs) across the US from 2009 to 2021.
The Epistemological Danger of Large Language Models
Authors: Elise Li Zheng, Sandra Soo-Jin Lee
Journal: The American Journal of Bioethics (2023)

Click to increase image sizeClick to decrease image sizeThis article refers to:What Should ChatGPT Mean for Bioethics?This article is referred to by:Generative-AI-Generated Challenges for Health Data Research DISCLOSURE STATEMENTNo potential conflict of interest was reported by the author(s).Additional informationFundingWe acknowledge support for this work from the National Science Foundation Grant 2220631 and the National Institutes of Health/National Center for Advancing Translational Sciences Grant 2UL1 TR001873-02.
Moving from Models to Responsible AI as a Moat
Authors: Ashwini Nagappan
Journal: The American Journal of Bioethics (2023)

Click to increase image sizeClick to decrease image sizeThis article refers to:What Should ChatGPT Mean for Bioethics? DISCLOSURE STATEMENTAN reported fees from Rock Health Inc as a Research Fellow.Additional informationFundingAN was supported by the NIH/National Center for Advancing Translational Science (NCATS) UCLA CTSI, under grant number TL1TR001883. The content is solely the responsibility of the author and does not represent the official views of the NIH.
What We Owe Those Who Chat Woe: A Relational Lens for Mental Health Apps
Authors: Anita Ho, Joseph Perry
Journal: The American Journal of Bioethics (2023)

Click to increase image sizeClick to decrease image sizeThis article refers to:What Should ChatGPT Mean for Bioethics? DISCLOSURE STATEMENTNo potential conflict of interest was reported by the author(s).Additional informationFundingThe author(s) reported there is no funding associated with the work featured in this article.
Cellular Uptake of Engineered Extracellular Vesicles: Biomechanisms, Engineered Strategies, and Disease Treatment
Authors: Qingpeng Xie, Yujia Hao, Na Li, Haoyue Song, Xiaohang Chen, Zilan Zhou, Jia Wang, Yuan Zhang, Huifei Li, Pengcheng Han, Xing Wang
Journal: Advanced Healthcare Materials (2023)

Extracellular vesicles (EVs), lipid-enclosed nanosized membrane vesicles, are regarded as new vehicles and therapeutic agents in intercellular communication. During internal circulation, if EVs are not effectively taken up by recipient cells, they will be cleared as "cellular waste" and unable to deliver therapeutic components. It can be seen that cells uptake EVs are the prerequisite premise for sharing intercellular biological information. However, natural EVs have a low rate of absorption by their recipient cells, off-target delivery, and rapid clearance from circulation, which seriously reduces the utilization rate. Affecting the uptake rate of EVs through engineering technologies is essential for therapeutic applications. Engineering strategies for customizing EV uptake can potentially overcome these limitations and enable desirable therapeutic uses of EVs. In this review, the mechanism and influencing factors of natural EV uptake will be described in detail. Targeting each EV uptake mechanism, the strategies of engineered EVs and their application in diseases will be emphatically discussed. Finally, the future challenges and perspectives of engineered EVs are presented multidimensionally.